Diabetes ( Xiao Ke) TCM refers to diabetes as Wasting-Thirst syndrome. Symptoms includes polydipsia, polyphagia, polyuria, and emaciation or sweat urine. The root of Wasting-Thirst is said to be a deficiency of Yin in the body and the presence of a Heat pathogen affecting the Lungs, Stomach, and Kidneys. Upper-Jiao: Lung dryness Middle-Jiao: Stomach heat Lower-Jiao: Kidney Yin def.

Etiology & Pathology 1. Improper or irregular dietary (diet that includes too many spicy and drying foods) Dysfunction of Sp. & St. Dryness & heat accumulation  fluid-deficiency Emotional disorder  Liver Qi stag.  Turn to fire  Liver & St. Yin def. Over working or o sexual activity  Consumption of Yin essence  deficient fire due to Yin def. lack of water in the body.

Main Points for differentiation Treatment protocol: Nourish Yin to promote the production of body fluid Moistening for dryness Clear away heat Organs Sym. Upper Jiao Lung Dryness Thirsty prefer drinking lots of water, frequent urine Middle Jiao Stomach Heat Too good appetite & dry stools Lower Jiao Kidney Def. Frequent & sweat urine

Diabetes involving upper-jiao Treatment Diabetes involving upper-jiao Signs & Symptoms: Main Sym. : Thirst, polydipsia, dry mouth & tongue. Concurrent sym.: frequent and profuse urine, gradual emaciation. Tongue: red color ( on the lip and edge of body), with thin yellow coating Pulse: full & rapid Treatment Protocol: Clear away heat Moistening the lung Promote production of body fluid

Formula: Modifications: Thirsty -- Ge Geng; Mai Dong; Yuan Shen; Clear Heat -- Huang Qin; irritability, thirsty, big & strong pulse -- Bai Hu Tang Xiao Ke Fang Huang Lian Tian Hua Feng Shen Di Lotus root Honey Fresh ginger juice

Diabetes involving middle-Jiao Treatment Diabetes involving middle-Jiao Signs & Symptoms: Main Sym. : Too good appetite, constipation Concurrent sym.: emaciation Tongue: dry & yellow coating Pulse: slippery & strong Treatment Protocol: Clear away stomach fire Tonifying yin-fluid

Modifications: Constipation Formula: Modifications: Constipation -- Zhen Ye Chen Qi Tang ( Da Huang, Mang Xiao, Xuan Shen, Mai Dong, Shen Di); Middle Jiao Heat: -- Da Huang + Gan Cao Avoiding bitter & cold herbs, should use more sweet, cold & moisten herbs Yu Nu Jian Shi Gao Shu Di Mai Dong Zhi Mu Niu Xi 应注意清火药不可过于苦寒，免伤胃气，应以甘寒滋润为主

Treatment Diabetes involving lower-Jiao Signs & Symptoms: Main Sym. : frequent & profuse urine, feverish sensation in palms & soles Concurrent sym.: turbid & sweat urine, dry mouth & lips, or even feverish sensation in the chest, palms and soles Tongue: red body Pulse: deep rapid and thready Treatment Protocol: Nourish Yin Tonify Kidney

Formula: Modifications: fever sensation -- Zhi Mu; Huang Bai; Wu Wei Zi; Long Gu; Mu Li; Gui Ban Profuse urine or greasy urine like fat -- Yi Zhi Ren; Sang Piao Qiao; Qi & Yin def. -- Dang Shen; Huang Qi Yin & Yang Def. -- Shen Qi Wan Liu Wei Di Huang Wan Shu Di Shan Yu rou Shan Yao Mu Dan Pi Zhi zi Ze Xie

-- Eliminate Dampness Case History 1 由昆医案 （现代名医医案精华四） 1. Male 45 years First visiting: Main complain: diabetes for years thirsty & drink a lot of water everyday, also with profuse urine, too good appetite, still feel weakness of whole body, keep losing weight for one year, and thin body type; Tongue: red body with white greasy coating Pulse: soft, slippery & rapid TCM diagnose: Kidney yin def. Damp heat in the Middle Jiao Treatment protocol: -- Nourish Yin -- Eliminate Dampness Formula: Cang Zhu 9, Dang Shen 9, Fu Ling 9, Huang Lian 1.5, Huang Qin 6, Zhi Mu 9, Ge Gen 6, Tian Hua Feng 12, tian Dong 12, Du Zhong 9, Tong Ji Li 9, Gou Ji 9, Ji Nei Jing 6, Pei Lan 9 X 10

Case History 1 周贤良医案 （现代名医医案精华四） 1. Male 45 years First visiting: Main complain: diabetes for 15 years irritability and thirsty, drink a lot of water everyday, dry eyes & tongue, frequent & profuse urine; Tongue: lightly red body with dry coating Pulse: thready TCM diagnose: Dry heat due to yin def. Lung & Kidney def. Treatment protocol: -- Clear away Lung heat & dryness -- Tonify Kidney Formula: Sha Shen 30, Zhi Mu 15, Shan Yu Rou 10, Tian Hua Feng 30, Ze Xie 10, Sheng Di 20, Ge Gen 10, Tian Dong 15, Mai Dong 15, Shan Yao 30

Painful Obstruction Symdrome ( Bi ) Indicates pain, soreness or numbness of muscles, tendons & joints from invasion of external wind, cold or dampness. Wind Bi Damp Bi Cold Bi Heat Bi Bone Bi The patient wants to urinate but the urine does not flow freely and he or she has distention and pain; when the patient dose not want to urinate, there is some dribbling.

Etiology & Pathology 1. Vital-Qi Def.  Wei Qi def.  Muscle & skin loosing  wind-evil attacking body and retaining in the joints & muscles Wind, Damp, Cold invading  blocking meridians

Joints painful swelling Hot painful swelling joints Main Points for differentiation Wind Bi: moving joints pain Cold Bi: severe fixed pain Damp Bi: heaviness of joints & sore pain Treatment protocol: Expel Wind Disperse Cold Eliminate Dampness Clear away Heat Wind-Cold-damp Wind-heat-Damp Joints painful swelling Hot painful swelling joints

Treatment Wind-Cold-Dampness (1) Wind Bi Signs & Symptoms: Main Sym. : moving joints pain Concurrent sym.: aversion to wind, fever, a feeling of wind in the joints, incapability of flexing and extending Tongue: light red body with thin & white coating Pulse: floating Treatment Protocol: Expel wind Dispelling cold Removing dampness Promoting blood circulation

Sore pain on upper body & limbs Formula: Modifications: Sore pain on upper body & limbs -- Qiang Huo; Jiang Huang; Chuan Xiong; Wei Ling Xian; Sang Zhi; Pain on the lower body -- Du Huo; Niu Xi; Mu Gua; Xu Duan; Sore pain on the back & spinal -- Sang Ji Shen; Du Zhong; Gu Sui Bu; Yin Yang Huo Fang Feng Tang Fang Feng Dang Gui Fu Ling Xin Ren Huang Qin Qin jiao Ge Geng Ma Huang Rou Gui Shen Jiang Gan Cao Da Zhao

Treatment Wind-Cold-Dampness (2) Cold Bi Signs & Symptoms: Main Sym. : severe fixed pain on the body or joints which is worse in cold and better in warm condition. Concurrent sym.: stiffness, incapability of flexing & extending Tongue: normal Pulse: floating & tense Treatment Protocol: Disperse cold Expel wind & dampness Removing dampness

-- Gui Zhi; Rou Gui; Xi Xin Long time illness Formula: Modifications: severe cold sym. -- Gui Zhi; Rou Gui; Xi Xin Long time illness -- Gu Sui Bu; Bu Gu Zhi; Ba Ji Tian; Yang Def. type constitution -- Yang He Tang Wu Tou Tang Chuan Wu Ma Huang Bai Shao Huang Qi Gan Cao

Treatment Wind-Cold-Dampness (3) Damp Bi Signs & Symptoms: Main Sym. : swelling, a heavy feeling, pain in the limbs and joint, numbness. Concurrent sym.: aching of the whole body, listless, heavy sensation in hands and feet, limited movement Tongue: white & greasy coating Pulse: soft & slow Treatment Protocol: Removing dampness Expelling wind Dispersing cold

-- Bei Xie; Mu Tong; Mu Gua; Fang Ji skin numbness Formula: Modifications: severe dampness -- Bei Xie; Mu Tong; Mu Gua; Fang Ji skin numbness -- Bai Zhu; Fang Feng; Bai Shao; Xi Xian Cao; Hai Tong Pi; Yi Yi Ren Tang Yi Yi Ren Chuan Xiong Dang Gui Ma Huang Gui Zhi Qiang Huo Du Huo Fang Feng Chuan Wu Cang Zhu Gan Cao Sheng jiang

Treatment Wind-Heat-Dampness (1) Heat Bi Signs & Symptoms: Main Sym. : pain & a feeling of burning heat in joints with red color skin, symptoms become severe when pressed, gets better when cooled; Concurrent sym.: fever, aversion to wind, sweating, thirst, irritability. Tongue: red body with yellow and dry coating Pulse: slippery & rapid Treatment Protocol: Clearing away heat Expel wind & eliminating dampness

Aversion to wind & fever -- Jing Yin Hua; Lian Qiao; Zhi Zi Formula: Modifications: sore & pain throat -- Yuan Shen; Jie Geng Aversion to wind & fever -- Jing Yin Hua; Lian Qiao; Zhi Zi High fever & thirsty -- Fresh Lu Gen; Tian Hua Feng; Xuan Shen; Shen Di; Joints pain -- Sang Zhi; Xi Xian Cao; Wei Ling Xian; Qin Jiao; Lu Xiang; Mo Yao; Di Long; Wu gong; Wu Shao She; Swelling & hot joints -- Dan Pi; Shen Di; Chi Shao; Zi Cao Bai Hu Gui Zhi Tang Zhi Mu Shi Gao Gan Cao Jing Mi Gui Zhi

Treatment Bone Bi Signs & Symptoms: Main Sym. : swelling & stiff joints; incapability of flexing & stiffness of whole body; Concurrent sym.: aching pain in the limbs and joints getting severe obviously, pain is worse at night or in raining day; stiffness occur only in the morning on the initial stage, further in all day. Often accompanied by weakness of knees, fatigue, liking warm and aversion to cold, irregular menstruation for female, emission and impotence for male. Tongue: red, pale, or dark body with blood stasis spot; white or yellow coating Pulse: deep thready or wiry pulse Treatment Protocol: Tonify Kidney Disperse cold Expelling wind & eliminating dampness Nourishing liver and the tendons

fatigue & thin body type -- Huang Qi; Dang Shen; Bai Zhu; Formula: Modifications: fatigue & thin body type -- Huang Qi; Dang Shen; Bai Zhu; Swelling & pain lower body joints -- Bei Xie; Fang Ji; Yi Yi Ren; Wei Ling Xian Blood stasis after long time illness -- Dan Shen; Tao Ren; Hong Hua; Ru xiang; Mo Yao; Zhi Bi Tang Gui Zhi Bai Shao Bu Gu Zhi Xu Duan Fu Zi Shu di Yin Yang Huo Du Huo Wei Ling Xian Gu Sui Bu Zhi Mu Niu Xi

Case History 1 王季儒医案 （四） 1. male 15 years First visiting: Main complain: tow legs painful for 7 m patient started feeling heaviness of two legs 7 m ago, then the pain started. Stiffness of knees but no swollen, high fever sometime, and diagnosed as rheumatic fever and treated by western medicine, however, patient’s symptoms got worse and worse, fingers & wrists all started swollen & stiffness & pain. High fever occurred every half of a month. Inability to stand up, hands couldn’t hold tightly too. Tongue: normal Pulse: deep fine & rapid TCM diagnose: Damp cold accumulating & block the meridians Treatment protocol: -- Expel damp cold Formula: Gui Zhi 6, Bai Shao 12, Fu Zi 6, Xi Xin 2, Ma Huang 3, Fang Feng 10, Bai Zhu 10, Ren dong Teng 30, Shen Jiang 3, Gan Cao 3